|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
IP
|
$11.16
|
|
|
Service Code
|
NDC 00536122858
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: PHP Commercial |
$9.49
|
| Rate for Payer: Aetna American Axle |
$7.25
|
| Rate for Payer: Aetna Commercial |
$9.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.25
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$9.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$10.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.25
|
| Rate for Payer: Priority Health SBD |
$7.03
|
| Rate for Payer: UMR Bronson Commercial |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.37
|
|
|
PHENOL 1.4 % MUCOSAL AEROSOL SPRAY
|
Facility
|
OP
|
$11.16
|
|
|
Service Code
|
NDC 00536122858
|
| Hospital Charge Code |
27889
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Aetna American Axle |
$7.25
|
| Rate for Payer: Aetna Commercial |
$9.49
|
| Rate for Payer: Aetna Medicare |
$5.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.25
|
| Rate for Payer: BCBS Complete |
$4.46
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$9.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$10.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.49
|
| Rate for Payer: PHP Commercial |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.25
|
| Rate for Payer: Priority Health SBD |
$7.03
|
| Rate for Payer: UMR Bronson Commercial |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.37
|
|
|
PHENOL 1.5 %-GLYCERIN 33 % MUCOSAL SPRAY
|
Facility
|
IP
|
$15.86
|
|
|
Service Code
|
NDC 78112000068
|
| Hospital Charge Code |
164911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$14.27 |
| Rate for Payer: Aetna American Axle |
$10.31
|
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.31
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$14.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.48
|
| Rate for Payer: PHP Commercial |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.31
|
| Rate for Payer: Priority Health SBD |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$6.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.90
|
|
|
PHENOL 1.5 %-GLYCERIN 33 % MUCOSAL SPRAY
|
Facility
|
OP
|
$15.86
|
|
|
Service Code
|
NDC 78112000068
|
| Hospital Charge Code |
164911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$14.27 |
| Rate for Payer: Aetna American Axle |
$10.31
|
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Aetna Medicare |
$7.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.31
|
| Rate for Payer: BCBS Complete |
$6.34
|
| Rate for Payer: Cash Price |
$12.69
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.69
|
| Rate for Payer: Healthscope Commercial |
$14.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.48
|
| Rate for Payer: PHP Commercial |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.31
|
| Rate for Payer: Priority Health SBD |
$9.99
|
| Rate for Payer: UMR Bronson Commercial |
$5.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.90
|
|
|
PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$309.10
|
|
|
Service Code
|
NDC 09900001943
|
| Hospital Charge Code |
150967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$278.19 |
| Rate for Payer: Aetna American Axle |
$200.92
|
| Rate for Payer: Aetna Commercial |
$262.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.92
|
| Rate for Payer: Cash Price |
$247.28
|
| Rate for Payer: Cofinity Commercial |
$216.37
|
| Rate for Payer: Cofinity Commercial |
$265.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.28
|
| Rate for Payer: Healthscope Commercial |
$278.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.74
|
| Rate for Payer: PHP Commercial |
$262.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.92
|
| Rate for Payer: Priority Health SBD |
$194.73
|
| Rate for Payer: UMR Bronson Commercial |
$136.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.82
|
|
|
PHENTOLAMINE 0.5 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$309.10
|
|
|
Service Code
|
NDC 09900001943
|
| Hospital Charge Code |
150967
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$114.37 |
| Max. Negotiated Rate |
$278.19 |
| Rate for Payer: Aetna American Axle |
$200.92
|
| Rate for Payer: Aetna Commercial |
$262.74
|
| Rate for Payer: Aetna Medicare |
$154.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.92
|
| Rate for Payer: BCBS Complete |
$123.64
|
| Rate for Payer: Cash Price |
$247.28
|
| Rate for Payer: Cofinity Commercial |
$216.37
|
| Rate for Payer: Cofinity Commercial |
$265.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$216.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.28
|
| Rate for Payer: Healthscope Commercial |
$278.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$216.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.74
|
| Rate for Payer: PHP Commercial |
$262.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.92
|
| Rate for Payer: Priority Health SBD |
$194.73
|
| Rate for Payer: UMR Bronson Commercial |
$114.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.82
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$1,671.75
|
|
|
Service Code
|
NDC 09900001945
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$735.57 |
| Max. Negotiated Rate |
$1,504.58 |
| Rate for Payer: Aetna American Axle |
$1,086.64
|
| Rate for Payer: Aetna Commercial |
$1,420.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.64
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cofinity Commercial |
$1,170.22
|
| Rate for Payer: Cofinity Commercial |
$1,437.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,170.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.40
|
| Rate for Payer: Healthscope Commercial |
$1,504.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.99
|
| Rate for Payer: PHP Commercial |
$1,420.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.64
|
| Rate for Payer: Priority Health SBD |
$1,053.20
|
| Rate for Payer: UMR Bronson Commercial |
$735.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.81
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$1,671.75
|
|
|
Service Code
|
NDC 09900001945
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$618.55 |
| Max. Negotiated Rate |
$1,504.58 |
| Rate for Payer: Aetna American Axle |
$1,086.64
|
| Rate for Payer: Aetna Commercial |
$1,420.99
|
| Rate for Payer: Aetna Medicare |
$835.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.64
|
| Rate for Payer: BCBS Complete |
$668.70
|
| Rate for Payer: Cash Price |
$1,337.40
|
| Rate for Payer: Cofinity Commercial |
$1,170.22
|
| Rate for Payer: Cofinity Commercial |
$1,437.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,170.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.40
|
| Rate for Payer: Healthscope Commercial |
$1,504.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,420.99
|
| Rate for Payer: PHP Commercial |
$1,420.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.64
|
| Rate for Payer: Priority Health SBD |
$1,053.20
|
| Rate for Payer: UMR Bronson Commercial |
$618.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.81
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
OP
|
$618.20
|
|
|
Service Code
|
NDC 09900001944
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$228.73 |
| Max. Negotiated Rate |
$556.38 |
| Rate for Payer: Aetna American Axle |
$401.83
|
| Rate for Payer: Aetna Commercial |
$525.47
|
| Rate for Payer: Aetna Medicare |
$309.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.83
|
| Rate for Payer: BCBS Complete |
$247.28
|
| Rate for Payer: Cash Price |
$494.56
|
| Rate for Payer: Cofinity Commercial |
$432.74
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.56
|
| Rate for Payer: Healthscope Commercial |
$556.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.47
|
| Rate for Payer: PHP Commercial |
$525.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.83
|
| Rate for Payer: Priority Health SBD |
$389.47
|
| Rate for Payer: UMR Bronson Commercial |
$228.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.65
|
|
|
PHENTOLAMINE 1 MG/ML IN NS SUBCUTANEOUS INJECTION CUSTOM
|
Facility
|
IP
|
$618.20
|
|
|
Service Code
|
NDC 09900001944
|
| Hospital Charge Code |
301530
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$272.01 |
| Max. Negotiated Rate |
$556.38 |
| Rate for Payer: Aetna American Axle |
$401.83
|
| Rate for Payer: Aetna Commercial |
$525.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.83
|
| Rate for Payer: Cash Price |
$494.56
|
| Rate for Payer: Cofinity Commercial |
$432.74
|
| Rate for Payer: Cofinity Commercial |
$531.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$494.56
|
| Rate for Payer: Healthscope Commercial |
$556.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$432.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$463.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.47
|
| Rate for Payer: PHP Commercial |
$525.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.83
|
| Rate for Payer: Priority Health SBD |
$389.47
|
| Rate for Payer: UMR Bronson Commercial |
$272.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$463.65
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
OP
|
$1,055.21
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$211.52 |
| Max. Negotiated Rate |
$1,183.89 |
| Rate for Payer: Aetna American Axle |
$685.89
|
| Rate for Payer: Aetna American Axle |
$900.41
|
| Rate for Payer: Aetna Commercial |
$1,177.46
|
| Rate for Payer: Aetna Commercial |
$896.93
|
| Rate for Payer: Aetna Medicare |
$410.42
|
| Rate for Payer: Aetna Medicare |
$410.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$493.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$493.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$493.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$493.29
|
| Rate for Payer: BCBS Complete |
$222.10
|
| Rate for Payer: BCBS Complete |
$222.10
|
| Rate for Payer: BCBS MAPPO |
$394.63
|
| Rate for Payer: BCBS MAPPO |
$394.63
|
| Rate for Payer: BCBS Trust/PPO |
$989.86
|
| Rate for Payer: BCBS Trust/PPO |
$989.86
|
| Rate for Payer: BCN Commercial |
$989.86
|
| Rate for Payer: BCN Commercial |
$989.86
|
| Rate for Payer: BCN Medicare Advantage |
$394.63
|
| Rate for Payer: BCN Medicare Advantage |
$394.63
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cofinity Commercial |
$1,191.32
|
| Rate for Payer: Cofinity Commercial |
$738.65
|
| Rate for Payer: Cofinity Commercial |
$907.48
|
| Rate for Payer: Cofinity Commercial |
$969.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$738.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$969.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.63
|
| Rate for Payer: Healthscope Commercial |
$949.69
|
| Rate for Payer: Healthscope Commercial |
$1,246.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$969.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$738.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.94
|
| Rate for Payer: Mclaren Medicaid |
$211.52
|
| Rate for Payer: Mclaren Medicaid |
$211.52
|
| Rate for Payer: Mclaren Medicare |
$394.63
|
| Rate for Payer: Mclaren Medicare |
$394.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.36
|
| Rate for Payer: Meridian Medicaid |
$222.10
|
| Rate for Payer: Meridian Medicaid |
$222.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$453.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.46
|
| Rate for Payer: Nomi Health Commercial |
$1,183.89
|
| Rate for Payer: Nomi Health Commercial |
$1,183.89
|
| Rate for Payer: PACE Medicare |
$374.90
|
| Rate for Payer: PACE Medicare |
$374.90
|
| Rate for Payer: PACE SWMI |
$394.63
|
| Rate for Payer: PACE SWMI |
$394.63
|
| Rate for Payer: PHP Commercial |
$896.93
|
| Rate for Payer: PHP Commercial |
$1,177.46
|
| Rate for Payer: PHP Medicare Advantage |
$394.63
|
| Rate for Payer: PHP Medicare Advantage |
$394.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$685.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,056.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,056.57
|
| Rate for Payer: Priority Health Medicare |
$394.63
|
| Rate for Payer: Priority Health Medicare |
$394.63
|
| Rate for Payer: Priority Health Narrow Network |
$845.26
|
| Rate for Payer: Priority Health Narrow Network |
$845.26
|
| Rate for Payer: Priority Health SBD |
$664.78
|
| Rate for Payer: Priority Health SBD |
$872.71
|
| Rate for Payer: Railroad Medicare Medicare |
$394.63
|
| Rate for Payer: Railroad Medicare Medicare |
$394.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,110.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,110.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.63
|
| Rate for Payer: UHC Exchange |
$754.18
|
| Rate for Payer: UHC Exchange |
$754.18
|
| Rate for Payer: UHC Medicare Advantage |
$394.63
|
| Rate for Payer: UHC Medicare Advantage |
$394.63
|
| Rate for Payer: UHCCP Medicaid |
$211.52
|
| Rate for Payer: UHCCP Medicaid |
$211.52
|
| Rate for Payer: UMR Bronson Commercial |
$390.43
|
| Rate for Payer: UMR Bronson Commercial |
$512.54
|
| Rate for Payer: VA VA |
$394.63
|
| Rate for Payer: VA VA |
$394.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.94
|
|
|
PHENTOLAMINE 5 MG INJECTION SOLUTION
|
Facility
|
IP
|
$1,055.21
|
|
|
Service Code
|
HCPCS J2760
|
| Hospital Charge Code |
10947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$464.29 |
| Max. Negotiated Rate |
$949.69 |
| Rate for Payer: Aetna American Axle |
$685.89
|
| Rate for Payer: Aetna American Axle |
$900.41
|
| Rate for Payer: Aetna Commercial |
$896.93
|
| Rate for Payer: Aetna Commercial |
$1,177.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.41
|
| Rate for Payer: Cash Price |
$844.17
|
| Rate for Payer: Cash Price |
$1,108.20
|
| Rate for Payer: Cofinity Commercial |
$969.68
|
| Rate for Payer: Cofinity Commercial |
$1,191.32
|
| Rate for Payer: Cofinity Commercial |
$738.65
|
| Rate for Payer: Cofinity Commercial |
$907.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$738.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$969.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.20
|
| Rate for Payer: Healthscope Commercial |
$949.69
|
| Rate for Payer: Healthscope Commercial |
$1,246.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$738.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$969.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$791.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,038.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,177.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$896.93
|
| Rate for Payer: PHP Commercial |
$1,177.46
|
| Rate for Payer: PHP Commercial |
$896.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$685.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.41
|
| Rate for Payer: Priority Health SBD |
$664.78
|
| Rate for Payer: Priority Health SBD |
$872.71
|
| Rate for Payer: UMR Bronson Commercial |
$464.29
|
| Rate for Payer: UMR Bronson Commercial |
$609.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$791.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,038.94
|
|
|
PHENYLEPHRINE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.32
|
|
|
Service Code
|
HCPCS J2373
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna American Axle |
$15.16
|
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.16
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$20.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.82
|
| Rate for Payer: PHP Commercial |
$19.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| Rate for Payer: Priority Health SBD |
$14.69
|
| Rate for Payer: UMR Bronson Commercial |
$10.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.49
|
|
|
PHENYLEPHRINE 0.1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.32
|
|
|
Service Code
|
HCPCS J2373
|
| Hospital Charge Code |
192051
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna American Axle |
$15.16
|
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna Medicare |
$0.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.08
|
| Rate for Payer: BCBS MAPPO |
$0.14
|
| Rate for Payer: BCBS Trust/PPO |
$0.40
|
| Rate for Payer: BCN Commercial |
$0.40
|
| Rate for Payer: BCN Medicare Advantage |
$0.14
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Cofinity Commercial |
$16.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.14
|
| Rate for Payer: Healthscope Commercial |
$20.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.49
|
| Rate for Payer: Mclaren Medicaid |
$0.08
|
| Rate for Payer: Mclaren Medicare |
$0.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.15
|
| Rate for Payer: Meridian Medicaid |
$0.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.82
|
| Rate for Payer: Nomi Health Commercial |
$0.42
|
| Rate for Payer: PACE Medicare |
$0.13
|
| Rate for Payer: PACE SWMI |
$0.14
|
| Rate for Payer: PHP Commercial |
$19.82
|
| Rate for Payer: PHP Medicare Advantage |
$0.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.44
|
| Rate for Payer: Priority Health Medicare |
$0.14
|
| Rate for Payer: Priority Health Narrow Network |
$0.35
|
| Rate for Payer: Priority Health SBD |
$14.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.14
|
| Rate for Payer: UHC Exchange |
$0.27
|
| Rate for Payer: UHC Medicare Advantage |
$0.14
|
| Rate for Payer: UHCCP Medicaid |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.63
|
| Rate for Payer: VA VA |
$0.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.49
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
NDC 45802018816
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna American Axle |
$6.18
|
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.18
|
| Rate for Payer: BCBS Complete |
$3.80
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$8.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.18
|
| Rate for Payer: Priority Health SBD |
$5.98
|
| Rate for Payer: UMR Bronson Commercial |
$3.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
NDC 45802018816
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna American Axle |
$6.18
|
| Rate for Payer: Aetna Commercial |
$8.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.18
|
| Rate for Payer: Cash Price |
$7.60
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Cofinity Commercial |
$8.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$8.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.08
|
| Rate for Payer: PHP Commercial |
$8.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.18
|
| Rate for Payer: Priority Health SBD |
$5.98
|
| Rate for Payer: UMR Bronson Commercial |
$4.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.12
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
IP
|
$11.63
|
|
|
Service Code
|
NDC 00536128806
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna American Axle |
$7.56
|
| Rate for Payer: Aetna Commercial |
$9.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.56
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: PHP Commercial |
$9.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health SBD |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.72
|
|
|
PHENYLEPHRINE 0.25 %-MINERAL OIL 14 %-PETROLATM 74.9 % RECTAL OINTMENT
|
Facility
|
OP
|
$11.63
|
|
|
Service Code
|
NDC 00536128806
|
| Hospital Charge Code |
167632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$10.47 |
| Rate for Payer: Aetna American Axle |
$7.56
|
| Rate for Payer: Aetna Commercial |
$9.89
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.56
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$10.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.89
|
| Rate for Payer: PHP Commercial |
$9.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health SBD |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.72
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
IP
|
$19.78
|
|
|
Service Code
|
NDC 00225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna American Axle |
$12.86
|
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: UMR Bronson Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.84
|
|
|
PHENYLEPHRINE 0.25 % NASAL SPRAY
|
Facility
|
OP
|
$19.78
|
|
|
Service Code
|
NDC 00225080047
|
| Hospital Charge Code |
6243
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$17.80 |
| Rate for Payer: Aetna American Axle |
$12.86
|
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna Medicare |
$9.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: BCBS Complete |
$7.91
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Cofinity Commercial |
$13.85
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.82
|
| Rate for Payer: Healthscope Commercial |
$17.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.81
|
| Rate for Payer: PHP Commercial |
$16.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health SBD |
$12.46
|
| Rate for Payer: UMR Bronson Commercial |
$7.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.84
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$94.75
|
|
|
Service Code
|
NDC 70756061430
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$85.28 |
| Rate for Payer: Aetna American Axle |
$61.59
|
| Rate for Payer: Aetna Commercial |
$80.54
|
| Rate for Payer: Aetna Medicare |
$47.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.59
|
| Rate for Payer: BCBS Complete |
$37.90
|
| Rate for Payer: Cash Price |
$75.80
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$81.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.80
|
| Rate for Payer: Healthscope Commercial |
$85.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.54
|
| Rate for Payer: PHP Commercial |
$80.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.59
|
| Rate for Payer: Priority Health SBD |
$59.69
|
| Rate for Payer: UMR Bronson Commercial |
$35.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.06
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$119.25
|
|
|
Service Code
|
NDC 17478020605
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.47 |
| Max. Negotiated Rate |
$107.32 |
| Rate for Payer: Aetna American Axle |
$77.51
|
| Rate for Payer: Aetna Commercial |
$101.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.51
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cofinity Commercial |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$83.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.40
|
| Rate for Payer: Healthscope Commercial |
$107.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.36
|
| Rate for Payer: PHP Commercial |
$101.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.51
|
| Rate for Payer: Priority Health SBD |
$75.13
|
| Rate for Payer: UMR Bronson Commercial |
$52.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.44
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$130.20
|
|
|
Service Code
|
NDC 42702010305
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.17 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna American Axle |
$84.63
|
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: Aetna Medicare |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.63
|
| Rate for Payer: BCBS Complete |
$52.08
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$111.97
|
| Rate for Payer: Cofinity Commercial |
$91.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$117.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.63
|
| Rate for Payer: Priority Health SBD |
$82.03
|
| Rate for Payer: UMR Bronson Commercial |
$48.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.65
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
OP
|
$119.25
|
|
|
Service Code
|
NDC 17478020605
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.12 |
| Max. Negotiated Rate |
$107.32 |
| Rate for Payer: Aetna American Axle |
$77.51
|
| Rate for Payer: Aetna Commercial |
$101.36
|
| Rate for Payer: Aetna Medicare |
$59.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.51
|
| Rate for Payer: BCBS Complete |
$47.70
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cofinity Commercial |
$102.56
|
| Rate for Payer: Cofinity Commercial |
$83.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.40
|
| Rate for Payer: Healthscope Commercial |
$107.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.36
|
| Rate for Payer: PHP Commercial |
$101.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.51
|
| Rate for Payer: Priority Health SBD |
$75.13
|
| Rate for Payer: UMR Bronson Commercial |
$44.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.44
|
|
|
PHENYLEPHRINE 10 % EYE DROPS
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 42702010305
|
| Hospital Charge Code |
19636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna American Axle |
$84.63
|
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.63
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$111.97
|
| Rate for Payer: Cofinity Commercial |
$91.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$117.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.63
|
| Rate for Payer: Priority Health SBD |
$82.03
|
| Rate for Payer: UMR Bronson Commercial |
$57.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.65
|
|
